Lichen planopilaris [cicatricial (scarring) alopecia] in a child

A mother of a 12-year-old boy, 2 years ago, noticed that he showed patchy l oss of hair on the vertex of the scalp. It was asymptomatic and progressive . Subsequently, similar patches appeared elsewhere on the scalp. Some of th ese patches joined to form a large bald patch. This was accompanied by dusk y blue eruptions over the left upper lip and eyebrows. Later, there was loc alized loss of hair. A family history of a similar ailment was absent. Examination of the scalp revealed plaques of alopecia with mild to moderate erythema. The skin was smooth, shiny, and atrophic (Fig. 1). Atrophy was a pparent by the presence of wrinkles In places, and by holding the skin betw een the thumb and the index finger. The periphery of the lesions was well d emarcated and was occupied by erythematous, scaly, follicular papules. Lesi ons were also located on the patches of alopecia. In addition, flat-topped, dusky blue, papules/plaques were present over the upper lip. A study of hematoxylin and eosin-stained microsections prepared from the up per lip and vertex of the scalp was undertaken. The former revealed hyperke ratosis, hypergranulosis, sawtooth irregular acanthosis, and destruction of the basal cell layer which, in turn, was embraced by a lymphohistiocytic i nfiltrate disposed in a band-like fashion. A few cells were seen invading t he epidermis. Pigment-laden histiocytes were found intermingled with the in filtrate. In the scalp skin, on the other hand, atrophy of the epidermis wi th punctuation of keratin plugs, together with fibrosis of the dermis, was prominent. The walls of the hair follicles were hyperkeratotic, while their lumina were conspicuous by their dilatation and contained keratotic plugs (Fig. 2a, b). Sebaceous and sweat glands were absent. Response to treatment, comprising ultramicronized griseofulvin (Gris O.D.) 375 mg/day (Sehgal VN, Abraham GJS, Malik GB. Griseofulvin therapy in liche n planus - a double blind controlled trial. Brl Dermatol 1972; 86: 383-385; Sehgal VN, Bikhchandani R, Koranne RV, et al. Histopathological: evaluatio n of griseofulvin therapy in lichen planus. A double blind controlled study . Dermatologica 1980; 161: 22-27) and prednisolone 20 mg/day for 6 months, was excellent (Fig. 3). Topical betamethasone dipropionate (Diprovate) loti on was used as a supplement.